Prevalência e fatores associados às malformações congênitas em nascidos vivos / Prevalencia y factores asociados a las malformaciones congénitas en nacidos vivos / Prevalence and factors associated with congenital malformations in live births

Resumo Objetivo: Estimar a prevalência de malformações congênitas e identificar os fatores associados em nascidos vivos. Métodos: Estudo transversal, de base populacional, com dados do Sistema de Informações sobre nascidos vivos. Procedeu-se a uma análise estatística bivariada (teste Qui-quadrado) e multivariada (regressão logística múltipla) para avaliar a associação entre as variáveis e o desfecho (nascidos vivos que possuem ou não malformações congênitas). Resultados: Registraram-se 346.874 nascidos vivos, desses 3.473 apresentaram algum tipo de malformação congênita, com prevalência média de 1,0%. Na análise múltipla os fatores, positivamente associados à prevalência foram: duração da gestação menor que 37 semanas (OR= 1,17), idade materna entre 20 e 29 anos (OR= 0,893), tipo de gravidez única (OR= 1,775), tipo de parto (OR= 0,827) e consultas de pré-natal inferior a seis (OR= 1,214). Conclusão: As variáveis apontadas no estudo integraram um modelo preditivo que pode auxiliar no planejamento dos serviços de saúde, sugerir hipóteses sobre os fatores etiológicos, e subsidiar as ações do pré-natal com atenção para os fatores identificados.

Resumen Objetivo: Estimar la prevalencia de malformaciones congénitas e identificar los factores asociados en nacidos vivos. Métodos: Estudio transversal, de base poblacional, con datos del Sistema de Información sobre nacidos vivos. Se procedió a un análisis estadístico bivariado (prueba χ2 de Pearson) y multivariado (regresión logística múltiple) para evaluar la relación entre las variables y el resultado (nacidos vivos que tienen o no tienen malformaciones congénitas). Resultados: Se registraron 346.874 nacidos vivos, de los cuales 3.473 presentaron algún tipo de malformación congénita, con prevalencia promedio de 1,0 %. En el análisis múltiple, los factores asociados de forma positiva a la prevalencia fueron: duración de la gestación menor a 37 semanas (OR= 1,17), edad materna entre 20 y 29 años (OR= 0,893), tipo de gestación única (OR= 1,775), tipo de parto (OR= 0,827) y consultas de atención prenatal inferiores a seis (OR= 1,214). Conclusión: Las variables observadas en el estudio integran un modelo predictivo que puede ayudar a la planificación de los servicios de salud, sugerir hipótesis sobre los factores etiológicos y respaldar las acciones de la atención prenatal con énfasis en los factores identificados.

Abstract Objective: To estimate the prevalence of congenital malformations and to identify associated factors in live births. Methods: Cross-sectional study, population-based, with data from the Live Births Information System. A bivariate statistical analysis (Chi-square test) and a multivariate statistical analysis (multiple logistic regression) were performed to evaluate the association between the variables and the outcome (live-births with or without congenital malformations). Results: A total of 346,874 live births were registered, of which 3,473 presented some type of congenital malformation, with an average prevalence of 1.0%. In the multiple analysis, the factors positively associated with prevalence were: duration of pregnancy less than 37 weeks (OR = 1.17), maternal age between 20 and 29 years (OR = 0.893), singleton pregnancy (OR = 1.775), type of delivery (OR - 0.827), and number of prenatal consultations inferior to six (OR = 1.214). Conclusion: The variables pointed out in the study integrated a predictive model that can help in the planning of health services, suggest hypotheses regarding etiological factors, and finance prenatal care actions with attention to the identified factors.

A importância do metilfolato na prevenção dos defeitos abertos do tubo neural / The importance of methylfolate in the prevention of open neural tube defects

A suplementação periconcepcional com vitamina B9 ou folato é considerada medida efetiva para diminuir a ocorrência e a recorrência de defeitos do tubo neural (DTNs). É recomendada para todas as mulheres que planejam gravidez ou que possam engravidar. O ácido fólico necessita passar por processos enzimáticos necessários à metabolização para a sua forma ativa L-5-metiltetrahidrofolato (L-metilfolato, 5-MTHF) envolvida nos processos biológicos e que circula no plasma. A enzima metilenotetrahidrofolato redutase (MTHFR) é de fundamental importância para fornecer 5-MTHF, forma biologicamente ativa. A presença de polimorfismo do gene da MTHF-redutase promove menor atividade enzimática e menor produção de L-metilfolato.(AU)

Asesoramiento genético a gestantes con defectos congénitos mayores / Genetic counseling to pregnant women with major congenital defects

Introducción: Los defectos congénitos mayores son resultado de un defecto de desarrollo intrínseco y desde su comienzo en un órgano o en una región anatómica. Su unión con otros formarán los síndromes caracterizados por un conjunto de defectos múltiples por malformación, disrupción o deformidad con afectación de varias áreas del desarrollo y con íntima relación histopatológica. Objetivo: Evaluar la efectividad del asesoramiento genético en gestantes basado en evidencias ultrasonográficas de defectos congénitos mayores. Métodos: Se realizó un estudio descriptivo transversal en el Policlínico José Martí Pérez del municipio de Santiago de Cuba. El universo estuvo conformado por la totalidad de las gestantes con evidencias ultrasonográficas de defectos congénitos mayores en los años 2016-2017. La información obtenida se procesó de forma computarizada y se aplicó el porcentaje como medida de resumen. Resultados: La aparición y detección de los defectos congénitos en las gestantes adolescentes afecta principalmente el sistema cardiaco, asociado a cromosomopatías, sistema renal, nervioso central, interrumpiéndose el mayor número de gestantes con defectos congénitos mayores. Conclusiones: Se evidenció que con el asesoramiento genético como herramienta de prevención de los defectos congénitos, se logró la terminación voluntaria del embarazo en la mayoría de los casos manteniendo la tasa de mortalidad infantil por debajo de los propósitos nacionales, mediante la detección precoz de los defectos congénitos en la Atención Primaria de Salud(AU)

Introduction: Major congenital defects result from any intrinsic development defect and from their beginning in an organ or in an anatomical region. Their union with others shall form the syndromes characterized by a set of multiple defects due to malformation, disruption or deformity with involvement of several development areas and with an intimate histopathological relationship. Objective: To evaluate the effectiveness of genetic counseling in pregnant women based on ultrasonographic evidence of major congenital defects. Methods: A cross-sectional descriptive study was carried out at José Martí Pérez Polyclinic in Santiago de Cuba Municipality. The study population was made up of all pregnant women with ultrasonographic evidence of major congenital defects in the years 2016 and 2017. The information obtained was processed in a computerized way and the percentage was applied as a summary measure. Results: The onset and detection of congenital defects in adolescent pregnant women mainly affects the cardiac system, associated to chromosomopathies, the renal system, the central nervous system, terminating the greater amount of pregnant women with major congenital defects. Conclusions: Genetic counseling was evidenced to be a tool for the prevention of congenital defects, by which voluntary termination of pregnancy can be achieved in most cases, keeping infant mortality rate below national purposes, through early detection of congenital defects in primary health care(AU)

Epilepsia na gravidez / Epilepsy in pregnancy

As epilepsias constituem uma das mais frequentes condições neurológicas encontradas na gravidez, ocorrendo entre 0,5% e 1% das gestações. O risco de morte materna está aumentado em 10 vezes nas grávidas epilépticas. Na gestante, o diagnóstico adequado é fundamental, já que deve ser afastada a possibilidade de se tratar de crise de eclâmpsia, doença exclusiva do período gravídico-puerperal. A preocupação materna quanto aos efeitos adversos (malformações) das drogas antiepilépticas no bebê pode levar à descontinuação ou redução da dose do medicamento, aumentando o risco de convulsão ou de morte súbita e inesperada na epilepsia (SUDEP). Nesta revisão foi dada atenção única e exclusiva às recomendações do Royal College of Obstetricians and Gynaecologists.(AU)

Epilepsiy is one of the most frequent neurological conditions found in pregnancy, occurring in 0.5 to 1% of pregnancies. The maternal death risk is increased 10-fold in epileptic pregnancies. In pregnant women, its adequate diagnosis is essential, since eclampsia is a differential diagnosis, which is disease exclusive to the pregnancy-puerperal period. Maternal concerns about the adverse effects (malformations) of antiepileptic drugs in the infant may lead to the discontinuation or reduction of the drug dose, increasing the risk of seizure or sudden and unexpected death in epilepsy (SUDEP). In this review exclusive attention was given to the recommendations of the Royal College of Obstetricians and Gynecologists.(AU)

Clinical recommendations for women exposed to Zika

Zika is an infectious disease that continues to pose an enduring threat worldwide. The disease is of particular concern to women of childbearing age, as the virus can cause devastating birth defects or fetal loss if acquired during pregnancy. Clinicians caring for women capable of becoming pregnant must inform women regarding the potential for Zika transmission via mosquito bites in affected regions as well as by sexual contact with exposed partners. Because of the global scope of the disease, clinicians caring for pregnant patients should evaluate for risk of Zika exposure to provide patients guidance in decision making related to virus prevention and testing.

Zika es una enfermedad infecciosa que aún representa una amenaza de largo plazo en todo el mundo. La enfermedad es especialmente peligrosa para las mujeres en edad fértil, ya que si se adquiere durante el embarazo, el virus puede causar defectos congénitos devastadores o pérdida del feto. Profesionales de la salud encargados del cuidado de las mujeres con planes de quedar embarazadas deberían informar a estas pacientes sobre el potencial de transmisión de Zika a través de picaduras de mosquitos en regiones afectadas, así como, por contacto sexual con parejas expuestas. Debido a los resultados de la extensión global de la enfermedad, los profesionales de salud que cuidan a las pacientes embarazadas también necesitan evaluar el riesgo de contacto con Zika para proporcionar orientación a los pacientes en la adopción de decisiones relacionadas con la prevención y las pruebas de este virus.

Comportamiento clínico epidemiológico de los defectos congénitos en La Habana / Clinical and epidemiological situation of congenital defects in La Habana province

INTRODUCCIÓN: los defectos congénitos son causa importante de morbilidad y mortalidad infantil porque representan un problema de salud global. En Cuba estos defectos constituyen la segunda causa de muerte en niños menores de un año, lo que hace necesario la existencia de sistemas de vigilancia que permitan analizar el comportamiento de estas alteraciones. OBJETIVO: caracterizar clínica y epidemiológicamente a los recién nacidos con defectos congénitos, así como describir el comportamiento de los defectos congénitos diagnosticados prenatalmente por los diferentes programas. MÉTODOS: se realizó un estudio observacional y descriptivo basado en la información del Registro Cubano de Malformaciones Congénitas correspondiente a un periodo de 5 años. Se estudiaron un total de 1 816 recién nacidos con defectos congénitos y 1 238 interrupciones terapéuticas voluntarias, para un total de 3 054 productos de la gestación con defectos congénitos. RESULTADOs: el 81,2 % de estos defectos fueron aislados, con respecto a las malformaciones múltiples los más frecuentes fueron los síndromes. Según el área de residencia, la mayor frecuencia de los defectos en nacidos vivos se presentó en Boyeros, con 272, y predominaron las interrupciones terapéuticas en Arroyo Naranjo con un total de 116. El 14,2 % de la mortalidad en niños menores de un año estuvo asociada a defectos congénitos. CONCLUSIONES: los defectos congénitos más frecuentes son los aislados, dentro de ellos, predominan las cardiopatías congénitas. Con respecto a los defectos congénitos múltiples, los más frecuentes son los síndromes. El municipio de Boyeros presenta el mayor número de nacimientos con defectos congénitos, mientras que el municipio de Arroyo Naranjo presenta el mayor número de interrupciones terapéuticas.

INTRODUCTION: congenital defects are significant causes of infant mortality and morbidity because they represent a global health problem. These defects in Cuba are the second cause of death in children aged less than one year, which makes it necessary to have surveillance systems that allow analyzing the behavior of these disorders. OBJECTIVE: to clinically and epidemiologically characterize the newborns with congenital defects as well as to describe the behavior of such defects diagnosed before birth by the different programs. METHODS: observational and descriptive study based on the information provided by the Cuban Register of Congenital Malformations in a 5 year period. One thousand and eight hundred sixteen newborn with congenital defects and 1 238 voluntary therapeutic abortions were studied for a total number of 3 054 gestational products with congenital defects. RESULTS: in the study, 81.2 % of these defects were single; in the multiple malformations the most common were syndromes. According to the area of residence, the highest frequency of defects in newborns was found in Boyeros municipality with 272 and the voluntary therapeutic abortions predominated in Arroyo Naranjo municipality with 116. The mortality rate of 14.2% in children under one year of age was associated to congenital defects. CONCLUSIONS: the most frequent congenital defects were single, being congenital cardiopathies predominant. Regarding the multiple congenital defects, syndromes were the most common. Boyeros municipality presented the highest number of births with congenital defects whereas Arroyo Naranjo municipality has the highest number of therapeutic abortions.

Amputación de miembro inferior derecho fetal con hipoplasia de hemipelvis y gastrosquisis como secuencia de amputación vascular / Amputation of right leg with fetal hypoplastic hemipelvis and gastroschisis as a sequence of vascular amputation

Las anomalías congénitas requieren un manejo multidisciplinario desde que se realiza el diagnóstico hasta la vida postnatal. Incluyen anomalías en el desarrollo tisular y deformidades, causadas por estresores mecánicos. Pueden ocurrir de forma aislada o como parte de un síndrome generalmente con causa genética. El principal diagnóstico antenatal se realiza por ultrasonido o bien, con la resonancia magnética. Tanto la gastrosquisis como los defectos óseos requieren un momento y lugar óptimos para nacimiento y manejo ya que de éstos depende su pronóstico y evolución...

Frequency and pattern of distribution of antenatally diagnosed congenital anomalies and the associated risk factors

To find the frequency and pattern of distribution of antenatally diagnosed congenital anomalies and the associated risk factors. This descriptive study was carried out at the department of Obstetrics and Gynecology, Lady Reading Hospital Peshawar from March 2012to April 2013. Women with ultrasound report of congenitally abnormal fetus irrespective of the gestational age were included. They were evaluated for the presence of risk factors including periconceptional use of folic acid, maternal medical disorders e.g diabetes, epilepsy and history of smoking, maternal and paternal ages, consanguineous marriages and family history of anomalies. A total of 62 women were included in the study. Fifty seven [91.9%] were having isolated anomalies while 5 [8.1%] presented with complex anomalies. Central nervous system [CNS] was the most commonly involved system [79%]. Lack of folic acid use and consanguineous marriages were two most important risk factors; however their correlation with congenital anomalies was not significant. Forty eight [77.4%] women have never used folic acid and consanguineous relation was present in 52 [83.9%]. Other risk factors like maternal medical disorder e.g. diabetes, epilepsy, maternal and paternal ages, family history and maternal smoking were non-significant. Lack of periconceptional use of folic acid and consanguineous marriages were two most important risk factors. Awareness among the general population and improvement in the antenatal care can help in the early detection and management of congenital anomalies

Descriptive Cases Sudy of Care; Surveillance and Prevention of Birth Defects in Rwandan Children

"""According to the World Health Statistics 2008; about 260 000 neonatal deaths worldwide are caused by Congenital anomalies. This fiure represents about 7 of all neonatal deaths"". In our study; birth accounted Defects for 14.9 out of 581 recruited infants with birth defects (87 cases). In this series; 52.9 were Female whereas 47.1 were male.13.8 were premature babies (=37weeks); 74.7 aged 5 months and 11.5 were infants aged between 5 and 12 months. Polymalformative conditions were the most common Cause of death identifid in 21 cases (24); gastrointestinal birth defects caused death in 15 cases (17); nervous system in 14 (16); Cardio-vascular birth defects in 10 cases (12); Chromosomal abnormalities In 10 cases (12); musculoskeletal defects in 10 cases (12); congenital mass in 2 cases (2); oral defects in 2 cases (2); congenital skin defect in 1 case(1); whereas congenital respiratory defect and genitourinary malformations in 1 case each (1).Over 50 patients died in referral hospitals and 77 died after 24 hours of life"

Ethanol induced developmental defects can be prevented with supplementation of vitamin E

Alcohol exposure during intrauterine life produces spectrum of disorders collectively termed as fetal alcohol syndrome. Apart from craniofacial and brain defects this syndrome produces various cardiac abnormalities such as atrial and ventricular septal defects, teratology of Fallot, transposition of the great arteries, truncus arteriosus. The mechanisms behind these ethanol-induced deficits are unknown. This study was conducted to detect the preventive role of lipid soluble vitamin E in ethanol induced heart malformations in chick embryos cultured in ovo. Experimental study. This study was conducted at the in the school of Biomedical Sciences, University of Nottingham, UK for a period of 6 months. White Leghorn chicken eggs were incubated for 3 days in 37 Degree °C with relative humidity of 100%. Eggs were microinjected with 100 micro l of either PBS, vitamin E 200 micro M, SOD 2 micro M, 20% ethanol in PBS, or ethanol plus vitamin E and ethanol plus SOD dissolved in PBS. On day 9 eggs were cracked and examined in terms of their viability. The viable embryos were examined for growth retardation by measuring crown rump length, and any malformations or gross abnormalities observed including limb deformities, facial defects, heart defects and brain vesicle development. Ethanol-induced alterations occurred in craniofacial development, vitelline circulation, crown rump length, facial abnormalities, brain development, which were prevented by addition of vitamin E and superoxide dismutase. These results show that exposure of the chick embryos to ethanol during development result in structural changes in the heart that mimic malformations that occur in patients with fetal alcohol syndrome [FAS]. These findings may be prevented with addition of vitamin E

Anomalías nefrourológicas congénitas en niños hospitalizados / Nephrourological congenital anomalies in children hospitalized

Introducción : las anomalías congénitas nefrourológicas se encuentran en segundo lugar en frecuencia entre las malformaciones detectadas por ecografía prenatal. La importancia del diagnóstico precoz radica en la posibilidad de prevenir infecciones urinarias, corregir la obstrucción urinaria y evitar o enlentecer el deterioro de la función renal. En nuestro país, el 30,4% de los menores de 15 años en diálisis crónica tiene una insuficiencia renal por nefrouropatía malformativa. Los objetivos fueron conocer la tasa de hospitalización, describir las características clínicas y evolutivas de los niños hospitalizados con diagnóstico ecográfico pre y postnatal de malformación nefrourológica. Material y métodos: estudio descriptivo, prospectivo. Se incluyeron los niños con ecografía del aparatourinario patológica hospitalizados en el sector de cuidados moderados del HP-CHPR entre 01/07/2012 y el 30/6/2013, se excluyeron aquellos con disfunción vesical o glomerulopatía crónica. Se valoró: edad, sexo, hallazgo ecográfico, diagnóstico nosológico, manifestaciones clínicas, evolución y tratamiento. Resultados: se incluyeron 44 niños, la tasa de hospitalización fue 3.9‰, relación masculino/femenino 1,9/1; la mediana de edad 23 meses (percentil 75: 91 meses). Se realizó ecografía prenatal en 36/44, de las cuales 18 fueron patológicas. Se controlaron ecográficamente luego del nacimiento 11/18. En los 26 pacientes restantes, el diagnóstico ecográfico se realizó en la etapa postnatal previo a la internación en 15 y durante la hospitalización en 11. El número de malformaciones halladas fue 66; 22 fueron bilaterales. Predominaron el reflujo vésicoureteral(n=19), las obstrucciones (n=15), y la agenesia/displasia renal (n=18). Requirieron tratamiento quirúrgico 21, endoscópico seis.(...)

Introduction: congenital abnormalities of urinary tract andkidneys rank second in frequency of structuralabnormalities on antenatal ultrasound. Early diagnosisallows to prevent urinary tract infections, to treat urinarytract obstruction and to avoid or slow the decline in renalfunction. In our country 30,4% of patients younger than 15years old on chronic dialysis have a kidney failurebecause of a congenital abnormality.The aims of this study were to know the hospitalizationrate and to describe clinic and evolutionary characteristicsof hospitalized children with a congenital abnormality ofurinary tract and kidneys diagnosed by antenatal/postnatal ultrasound.Patients and methods: a descriptive and prospectivestudy was performed. Hospitalized children in HP-CHPR,between 01/07/2012 and 30/06/2013, with pathologicultrasound of kidneys or urinary tract, were included.Children with bladder dysfunction or glomerulopathy wereexcluded. We considered age, gender, ultrasoundfindings, definitive diagnosis, clinic manifestations,treatment and outcome.Results: we included 44 children. Hospitalization rate was3.9 0/00, the relation male/female was 1.9/1 and themedian age 23 months (75th percentile: 91 months).Antenatal ultrasound was performed in 36/44 patients; 18of them were pathologic; among these last ones, 11/18underwent postnatal ultrasound to control findings. In theother 26 patients, the diagnosis of pathologic ultrasoundwas made after birth: in 15 of them before thehospitalization and in 11 during the hospitalization. Wefound 66 affected kidneys; 22 were bilateral. The mostfrequent diagnosis were: vesicoureteric reflux (n=19),obstruction (n=15) and renal dysplasia/ agenesis (n=18).Twenty one patients underwent surgical treatment and 6underwent endoscopic treatment; 8 patients receivedmore than one invasive treatment...

Anomalías congénitas / Congenital anomalies

Las anomalías congénitas en conjunto con la restricción del crecimiento intrauterino dan cuenta del 50 a 60 por ciento de la mortalidad fetal. En este artículo se describen las malformaciones congénitas más importantes divididas por sistemas, la mayoría son diagnosticables a través del ultrasonido; sin embargo, hay un grupo de ellas que no son posibles de diagnosticar, otras que se desarrollan tardíamente en el embarazo y finalmente existen casos en que el examen ultrasonográfico puede sugerir una anormalidad inexistente. También se profundiza en la incidencia, etiología y factores de riesgo de las malformaciones congénitas, se describe la importancia y características del diagnóstico prenatal y de la prevención por medio de la suplementación de ácido fólico en la dieta.

Congenital anomalies in conjunction with intrauterine growth restriction account for 50-60 percent of fetal mortality. This article describes major birth defects by systems; most can be diagnosed by ultrasound while others cannot. Some anomalies develop later in pregnancy and in some cases sonographic examination may suggest the presence of a nonexistent abnormality. Incidence, etiology and risk factors of congenital malformations are described, as well as the importance and characteristics of prenatal diagnosis and prevention through folic acid supplementation in the diet.

Corrección de gastrosquisis transparto una oportunidad de mejorar la calidad de atención para esta anomalía congénita / Correction of gastroschisis transparto an opportunity to improve the quality of care for this congenital

La gastrosquisis es un efecto congénito del cierre de la pared abdominal, se manifiesta usualmente al lado izquierdo del cordón umbilical se cree que la causa puede estar asociada a la ingesta de AINES en el primer trimestre del embarazo. El manejo convencional de estos recién nacidos es permitir el parto de termino en el Hospital de Maternidad, trasladar al Hospital de Niños "Benjamín Bloom", colocar "Silos" y realizar cirugía correctora del defecto esto luego de estar ingresados varias semanas y a veces meses con alto riesgo de morbilidad y mortalidad por sepsis...

Estudio retrospectivo sobre las posibles complicaciones maternofetales de la exposición a cabergolina / Retrospective Study of any potencial Adverse Effects of Cabergoline on Pregnancy and Embryofetal Development

Objetivos: Estimar la frecuencia de complicaciones maternofetales en mujeres que se embarazaron durante el tratamiento con cabergolina (CAB). Estimar la frecuencia de patología detectada posnacimiento en los niños producto de dichos embarazos. Material y métodos: Estudio retrospectivo y multicéntrico de 86 embarazos en 78 mujeres con hiperprolactinemia idiopática (7) o tumoral (44 micro y 27 macro), en tratamiento con CAB en el momento de la concepción. Edad: 20 a 45 años; PRL inicial: 30 a 1429 ng/ml; duración del tratamiento previo al embarazo 1 a 120 meses; dosis: 0.125 a 4 mg/semana. El rango de exposición embriofetal a la CAB fue de 3 a 27 semanas, el 96.39% de las pacientes la recibió durante el primer trimestre y el 3.61% hasta el segundo. Resultados: No hubo complicaciones mayores durante el embarazo. Se registraron 7 abortos espontáneos (8.1%) y 75 partos, de los cuales 49 fueron vaginales y 26 cesáreas. Se registraron 69 recién nacidos, 63 fueron a término y 6 pretérmino (8.8%), ninguno bajo peso para la edad gestacional. En 3 (5.2%) recién nacidos se observó: 1 malformación mayor (Síndrome de Down) y 2 menores (hernia umbilical e inguinal). Se obtuvo seguimiento de 42 recién nacidos; se diagnosticó epilepsia refractaria en uno y un trastorno generalizado del desarrollo en otro. No se halló una mayor frecuencia de complicaciones en los embarazos ni en los recién nacidos expuestos a CAB que en la población normal. Sería necesario mayor número de pacientes para concluir sobre la seguridad de CAB durante el embarazo.

Objectives: To assess the rate of any potential adverse effects on pregnancy and embryo-fetal development in women who became pregnant under treatment with cabergoline (CAB). To follow up medical data of children who were born from mothers exposed to Cab in early weeks of gestation. Material and methods: Observational, retrospective and multicenter study on 86 pregnancies in 78 women with idiopathic or tumoral hyperprolactinemia. All patients were under Cab at conception. The average age was 29 (range: 20-45). Pituitary images at diagnosis showed 44 microadenomas, 27 macroadenomas and 7 were normal. Serum PRL at baseline was between 30 and 1429 ng/ml. Duration of therapy before pregnancy ranged from 1 to 120 months. Maternal and fetal exposure to cabergoline and doses ranged from 0.125 to 4 mg/week. The mean serum PRL level under which patients achieved pregnancy was 17 ng/ml. Fetal exposure ranged from 3 to 27 weeks; 96.39% of patients received CAB during the first trimester of pregnancy and 3.61% until the second one. Results: No significant complications during pregnancy were found. Seven women (8.1%) had spontaneous abortions. Term deliveries were recorded in 63/69, preterm in six (8.8%), none of them with low weight for gestational age. Neonatal abnormalities were observed in 3 (5.2%): 1 major (Down syndrome) and 2 minor malformations (umbilical and inguinal hernia). Two out of 42, developed abnormalities during the follow- up, one of them was a refractory epilepsy during the second month of life, the other presented a Pervasive Developmental Disorder diagnosed in the third year of life. Conclusion: No significantly higher frequency of complications was found in pregnancies and/or offspring exposed to CAB than in normal population. Larger series of patients are needed to asses the safety.

Ácido fólico na prevenção de gravidez acometida por morbidade fetal: aspectos atuais / Folic acid in prevention of pregnancy affected by fetal morbidity: actual aspects

Os estudos em países desenvolvidos sugerem uma tendência à redução da incidência e gravidade dos defeitos abertos do tubo neural (DATN), após a adoção de programas de fortificação de grãos e farináceos. No Brasil, a mesma tendência foi observada, porém não com a mesma intensidade, decorrente da diversidade dos hábitos alimentares regionais, inferindo que apenas a adoção do programa de fortificação não seja suficiente para haver redução significativa dos DATN. O papel do ácido fólico na prevenção de malformações do tubo neural está bem definido. A prevenção de cardiopatias, malformações faciais e cromossomopatias ainda permanece incerta, sendo necessários estudos para avaliar a ação do micronutriente na profilaxia de outras morbidades fetais. Constatou-se aumento do conhecimento de pacientes e profissionais de saúde envolvidos na assistência pré-natal sobre o papel do ácido fólico e, em particular, no seu uso periconcepcional especialmente em países desenvolvidos. Assim, apesar dos programas de fortificação implantados em alguns países desenvolvidos terem sido eficientes em reduzir de forma significativa a incidência dos DFTN, no Brasil, precisam-se considerar as variações regionais e promover melhor a suplementação farmacológica do ácido fólico periconcepcional

Studies in developed countries have suggested a tendency of reduction in incidence and severity of neural tube defects (NTD), after the adoption of folic acid food fortification programs. In Brazil, the same trend was observed; however not with the same intensity. This finding seems to be associated with the great diversity of the Brazilian regional alimentary habits, leading some researchers to infer that only foods fortification programs are not enough to reach a significant reduction of NTD incidence. The knowledge of folic acid prevention of NTD malformations is well-established by consistent publications. It is not completely clear the folate role in preventing congenital cardiopathies, facial malformations and cromossomic disorders. An increase in patients and physicians' knowledge about folic acid role in the prevention of NTD malformations was noticed. Its periconceptional use has increased more significantly especially in developed countries. Although food fortification programs in some developed countries have been efficient in reducing significantly the incidence and severity of NTD malformations, in Brazil, the program must consider regional variations and improve folate promotion for medical supplementation in periconceptional folic acid